Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement...Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group （n = 81） who received vacuum sealing drainage for healing of the wound or a control group （n = 81） who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group （21.2 ± 7.8 days, P 〈 0.05）, while the medical costs showed no significant difference between the two groups （P 〉 0.05）. Seventy-eight patients （96.29%） in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after heart valve surgery through midsternal incision approach could achieve good therapeutic efficacy, with shorter wound healing time and similar costs as traditional treatment.展开更多
Heart failure is a common condition in elderly patients.With further population aging,incidence of heart failure is constantly increasing.When heart failure occurs in this group of patients,clinical symptoms may vary ...Heart failure is a common condition in elderly patients.With further population aging,incidence of heart failure is constantly increasing.When heart failure occurs in this group of patients,clinical symptoms may vary vastly,rendering difficulty for the treatment process and leading to poor efficacy and prognosis.To gain better under-standing on clinical symptoms and signs of heart failure in elderly patients,to provide prevention and treatment against heart failure for elderly patients in terms of nursing care and to improve success rate of salvage treatment as well as nurs-ing quality.Methods Retrospective analysis was performed in 141 patients with heart failure who were treated in our hospital during January 2005 and December 2009.Those aged > 60 years were assigned to elderly group while those aged < 60 years were assigned to non elderly group.These two groups were compared in terms of clinical symptoms, signs and physical and laboratory examinations.Results Clinical symptoms and signs of heart failure tended to be a-typical in elderly patients.Symptoms including cough,sputum,increased heart rate and mental disorder were frequent, and a substantial proportion of patients had pulmonary congestion and edema.Conclusions Prevention and specific nursing measures should be aggressively taken based on the features of heart failure in elderly patients.Frequency of in-spection particularly observation on atypical symptoms should be increased to provide intensive monitoring.展开更多
Background Myocardial impairment is often precipitated after burn. Previously, cardiac enzyme profile was often measured to determine myocardial injury, but was hardly specific. In this study, we investigated early ch...Background Myocardial impairment is often precipitated after burn. Previously, cardiac enzyme profile was often measured to determine myocardial injury, but was hardly specific. In this study, we investigated early changes of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） over time and its diagnostic value in burn patients. Methods 131 patients with heat burn were assigned to mild group （n = 19）, moderate group （n = 31）, severe group （n = 35） and extremely severe group （n = 35） based on their conditions. NT-proBNP and troponin I （cTnI） were continuously measured on days 1, 3, 5 and 7, respectively after admission. Results Significant differences were found on day 3, 5 and 7 between moderate burn group and mild burn group （P 0.05）; increase appeared earlier and lasted longer in severe group and extremely severe group as compared to mild and moderate groups （P 0.05）. Conclusions NT-proBNP is related to the severity of burn and can well reflect the status of myocardial injury in patients with severe burn, making it an ideal marker for myocardial injury in burn patients.展开更多
The most common symptom of acute myocardial infarction(AMI) patients is chest pain,rarely the otorhinolaryngological discomfort.We approach the clinical characters of AMI patients firstly diagnosed as otorhinolar-yngo...The most common symptom of acute myocardial infarction(AMI) patients is chest pain,rarely the otorhinolaryngological discomfort.We approach the clinical characters of AMI patients firstly diagnosed as otorhinolar-yngological diseases to lessen the misdiagnosis.Methods To review the 18 AMI patients firstly diagnosed as otorhin-laryngological diseases,and analyze their clinical manifestations and laboratory data.Results Eighteen AMI patients had atypical or no retrosternal discomfort.Among them,six patients visited their doctors for pharyngalgia,four for a-cute pharyngitis,five for vertigo,one for esophageal foreign objects,one for burning pain of facies nasalis,one for misdiagnosed internal otitis.The final diagnoses were: ten simple inferior wall myocardial infarction,6 anterior wall in-farction,2 inferior wall complicated with posterior wall infarction.Both myocardial enzymes and troponin tests showed the AMI changes.Conclusions the AMI patients firstly diagnosed as otorhinlaryngological diseases have no or atypical symptoms.They need to be overall examined and have the electrocardiogram (ECG) examination; the suspects should undergo myocardial enzyme and troponin tests and multiple consultations to avoid misdiagnosis and mistreatment,lower the fatality and decrease the malpraxis.展开更多
Background Currently used heart valve prostheses are associated with anticoagulation complications or limited durability. The advancement of stem cell study and tissue-engineered heart valve research may offer a relat...Background Currently used heart valve prostheses are associated with anticoagulation complications or limited durability. The advancement of stem cell study and tissue-engineered heart valve research may offer a relatively ideal solution to these problems. Methods Bone marrow was aspirated from sternum of lamb goats to isolate BMCs. Cells were identified by flow cytometry and its capacity of differentiation. Cellular viability was assessed with Rhdomine 123 staining. 1 × 10^7cells were seeded on a patch of PGA sheet. After two-day in vitro culture, autologous cell/ scaffold sheets were used to replace the right posterior pulmonary valve leaflets under cardiopulmonary bypass. The leaflets were explanted at 2 days, 2, 6, 8 and 10 weeks after implantation. The samples were examined macroscopically, histologically, immunohistochemically, and by Scanning Electron Microscope （SEM）. Two goats were implanted with acellular sheets and established as a control group. Results BMCs exhibited fibroblastoid morphology with good viability. Flow cytometry showed negative CD14 and CD45 expression. In vitro cultured BMCs demonstrated the potential to differentiate into adipocytes. The explanted leaflets resembled the characteristics of native extracellular matrix was leaflets macroscopicaIly in the cellular group. Histology showed synthesized and cells were distributed in the single-layered leaflets.Immunohistochemistry revealed positive staining for yon Willebrand factor, α-SMA, vimentin. A confluent cell surface was formed on the explanted TEHLs. No calcium deposited on the leaflets. In control group, the acellular scaffolds were completely degraded, without leaflet remained at 8 weeks. Conclusions It is possible to create tissue-engineered heart valves in vivo using autologous bone marrow-derived cells.展开更多
基金supported by Medical Scientific Research Foundation of Guangdong Province(No. B2013019)grants from Administration of Traditional Chinese Medicine of Guangdong Province (No. 20121258 & No. 20132075)
文摘Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group （n = 81） who received vacuum sealing drainage for healing of the wound or a control group （n = 81） who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group （21.2 ± 7.8 days, P 〈 0.05）, while the medical costs showed no significant difference between the two groups （P 〉 0.05）. Seventy-eight patients （96.29%） in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after heart valve surgery through midsternal incision approach could achieve good therapeutic efficacy, with shorter wound healing time and similar costs as traditional treatment.
文摘Heart failure is a common condition in elderly patients.With further population aging,incidence of heart failure is constantly increasing.When heart failure occurs in this group of patients,clinical symptoms may vary vastly,rendering difficulty for the treatment process and leading to poor efficacy and prognosis.To gain better under-standing on clinical symptoms and signs of heart failure in elderly patients,to provide prevention and treatment against heart failure for elderly patients in terms of nursing care and to improve success rate of salvage treatment as well as nurs-ing quality.Methods Retrospective analysis was performed in 141 patients with heart failure who were treated in our hospital during January 2005 and December 2009.Those aged > 60 years were assigned to elderly group while those aged < 60 years were assigned to non elderly group.These two groups were compared in terms of clinical symptoms, signs and physical and laboratory examinations.Results Clinical symptoms and signs of heart failure tended to be a-typical in elderly patients.Symptoms including cough,sputum,increased heart rate and mental disorder were frequent, and a substantial proportion of patients had pulmonary congestion and edema.Conclusions Prevention and specific nursing measures should be aggressively taken based on the features of heart failure in elderly patients.Frequency of in-spection particularly observation on atypical symptoms should be increased to provide intensive monitoring.
文摘Background Myocardial impairment is often precipitated after burn. Previously, cardiac enzyme profile was often measured to determine myocardial injury, but was hardly specific. In this study, we investigated early changes of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） over time and its diagnostic value in burn patients. Methods 131 patients with heat burn were assigned to mild group （n = 19）, moderate group （n = 31）, severe group （n = 35） and extremely severe group （n = 35） based on their conditions. NT-proBNP and troponin I （cTnI） were continuously measured on days 1, 3, 5 and 7, respectively after admission. Results Significant differences were found on day 3, 5 and 7 between moderate burn group and mild burn group （P 0.05）; increase appeared earlier and lasted longer in severe group and extremely severe group as compared to mild and moderate groups （P 0.05）. Conclusions NT-proBNP is related to the severity of burn and can well reflect the status of myocardial injury in patients with severe burn, making it an ideal marker for myocardial injury in burn patients.
文摘The most common symptom of acute myocardial infarction(AMI) patients is chest pain,rarely the otorhinolaryngological discomfort.We approach the clinical characters of AMI patients firstly diagnosed as otorhinolar-yngological diseases to lessen the misdiagnosis.Methods To review the 18 AMI patients firstly diagnosed as otorhin-laryngological diseases,and analyze their clinical manifestations and laboratory data.Results Eighteen AMI patients had atypical or no retrosternal discomfort.Among them,six patients visited their doctors for pharyngalgia,four for a-cute pharyngitis,five for vertigo,one for esophageal foreign objects,one for burning pain of facies nasalis,one for misdiagnosed internal otitis.The final diagnoses were: ten simple inferior wall myocardial infarction,6 anterior wall in-farction,2 inferior wall complicated with posterior wall infarction.Both myocardial enzymes and troponin tests showed the AMI changes.Conclusions the AMI patients firstly diagnosed as otorhinlaryngological diseases have no or atypical symptoms.They need to be overall examined and have the electrocardiogram (ECG) examination; the suspects should undergo myocardial enzyme and troponin tests and multiple consultations to avoid misdiagnosis and mistreatment,lower the fatality and decrease the malpraxis.
基金supported by the grant from Guangdong Nature Science Foundation(7001117)
文摘Background Currently used heart valve prostheses are associated with anticoagulation complications or limited durability. The advancement of stem cell study and tissue-engineered heart valve research may offer a relatively ideal solution to these problems. Methods Bone marrow was aspirated from sternum of lamb goats to isolate BMCs. Cells were identified by flow cytometry and its capacity of differentiation. Cellular viability was assessed with Rhdomine 123 staining. 1 × 10^7cells were seeded on a patch of PGA sheet. After two-day in vitro culture, autologous cell/ scaffold sheets were used to replace the right posterior pulmonary valve leaflets under cardiopulmonary bypass. The leaflets were explanted at 2 days, 2, 6, 8 and 10 weeks after implantation. The samples were examined macroscopically, histologically, immunohistochemically, and by Scanning Electron Microscope （SEM）. Two goats were implanted with acellular sheets and established as a control group. Results BMCs exhibited fibroblastoid morphology with good viability. Flow cytometry showed negative CD14 and CD45 expression. In vitro cultured BMCs demonstrated the potential to differentiate into adipocytes. The explanted leaflets resembled the characteristics of native extracellular matrix was leaflets macroscopicaIly in the cellular group. Histology showed synthesized and cells were distributed in the single-layered leaflets.Immunohistochemistry revealed positive staining for yon Willebrand factor, α-SMA, vimentin. A confluent cell surface was formed on the explanted TEHLs. No calcium deposited on the leaflets. In control group, the acellular scaffolds were completely degraded, without leaflet remained at 8 weeks. Conclusions It is possible to create tissue-engineered heart valves in vivo using autologous bone marrow-derived cells.
